Provider Demographics
NPI:1023698537
Name:PRIME ORTHOPEDIC REHABILITATION LLC
Entity type:Organization
Organization Name:PRIME ORTHOPEDIC REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PORATH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:201-503-7173
Mailing Address - Street 1:111 DEAN DR
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2764
Mailing Address - Country:US
Mailing Address - Phone:201-503-7173
Mailing Address - Fax:201-503-7177
Practice Address - Street 1:4065 YARMOUTH D
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4544
Practice Address - Country:US
Practice Address - Phone:917-797-0583
Practice Address - Fax:201-503-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy